Sunday, January 10, 2016

False Diagnosis of ADHD

ADHD is spreading like wildfire.  It used to be confined to a small percentage of kids who had clear-cut problems that started at a very early age and caused them unmistakeable difficulties in many situations.  Then all manner of classroom disruption was medicalized and ADHD was applied so promiscuously that an amazing 10 percent of kids now qualify.  Every classroom now has at least one or two kids on medication.  And increasingly, ADHD is becoming an explain-all for all sorts of performance problems in adults as well.

How could this possibly happen?  There were six contributors: wording changes in DSM-IV; heavy drug company marketing to doctors and advertising to the general public; extensive media coverage; pressure from harried parents and teachers to control unruly children; extra time given on tests and extra school services for those with an ADHD diagnosis; and finally, the widespread misuse of prescription stimulants for general performance enhancement and recreation.

The most obvious explanation is by far the least likely—that the real prevalence of attentional and hyperactivity problems has actually increased.  There is no reason to think the kids have changed, it is just that the labels have.  We now diagnose as mental disorder attentional and behavioral problems that used to be seen as part of life and of normal individual variation.  The most convincing evidence of this comes from a large study with a particularly disturbing finding.  A child’s date of birth was a very powerful predictor of whether or not he would get the diagnosis of ADHD.  Boys born in January were at 70 percent higher risk than those born in December simply because January 1 was the cutoff for grade assignment.  The youngest, least developmentally mature kids in the class are much more likely to get the ADHD diagnosis.  The birthday effect was almost as influential in girls.  We have turned being immature because being young into a disease to be treated with a pill.

Allen Frances, M.D, "Saving Normal," pg.141-142

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